Immunization Programs for Infants, Children, Adolescents, and Adults: Clinical Practice Guidelines by the Infectious Diseases Society of America pot

IDSA GUIDELINES Immunization Programs for Infants, Children, Adolescents, and Adults: Clinical Practice Guidelines by the Infectious Diseases Society of America Larry K Pickering,1 Carol J Baker, Gary L Freed, Stanley A Gall, Stanley E Grogg, Gregory A Poland, Lance E Rodewald, William Schaffner, Patricia Stinchfield, Litjen Tan, Richard K Zimmerman, and Walter A Orenstein National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia EXECUTIVE SUMMARY Immunization is one of the most beneficial and costeffective disease prevention measures [1] Successes of immunization include worldwide eradication of small- Received 22 May 2009; accepted 24 May 2009; electronically published August 2009 Reprints or correspondence: Dr Larry K Pickering, National Center for Immunization and Respiratory Diseases, Executive Secretary, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-05, Atlanta, GA 30333 (LPickering@cdc.gov) Clinical Infectious Diseases 2009; 49:817–40 ᮊ 2009 by the Infectious Diseases Society of America All rights reserved 1058-4838/2009/4906-0001$15.00 DOI: 10.1086/605430 pox, control of poliomyelitis with hopes of eradication, and elimination of indigenous measles and rubella in the United States [2, 3], although the 2008 upsurge in measles cases serves as a reminder that measles is still imported into the United States [4] The incidence of most other vaccine-preventable diseases, excluding pertussis and tetanus, has shown a reduction of у99%, compared with the annual morbidity prior to devel- These guidelines were developed and issued on behalf of the Infectious Diseases Society of America (IDSA) It is important to realize that guidelines cannot always account for individual variation among patients They are not intended to supplant physician judgment with respect to particular patients or special clinical situations The IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances IDSA Immunization Guidelines • CID 2009:49 (15 September) • 817 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Evidence-based guidelines for immunization of infants, children, adolescents, and adults have been prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA) These updated guidelines replace the previous immunization guidelines published in 2002 These guidelines are prepared for health care professionals who care for either immunocompetent or immunocompromised people of all ages Since 2002, the capacity to prevent more infectious diseases has increased markedly for several reasons: new vaccines have been licensed (human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap] vaccine; and zoster vaccine), new combination vaccines have become available (measles, mumps, rubella and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine), hepatitis A vaccines are now recommended universally for young children, influenza vaccines are recommended annually for all children aged months through 18 years and for adults aged у50 years, and a second dose of varicella vaccine has been added to the routine childhood and adolescent immunization schedule Many of these changes have resulted in expansion of the adolescent and adult immunization schedules In addition, increased emphasis has been placed on removing barriers to immunization, eliminating racial/ethnic disparities, addressing vaccine safety issues, financing recommended vaccines, and immunizing specific groups, including health care providers, immunocompromised people, pregnant women, international travelers, and internationally adopted children This document includes 46 standards that, if followed, should lead to optimal disease prevention through vaccination in multiple population groups while maintaining high levels of safety opment of the corresponding vaccine (Table 1) [7] An analysis of clinical preventive measures widely recommended by the US Preventive Services Task Force reported that childhood immunization was of only services that received a perfect score of 10 (ie, top tier for both the clinical burden that the vaccines could prevent and cost-effectiveness to society) based on clinically preventable disease burden and cost-effectiveness Immunization of adults aged у50 years with influenza vaccine and adults aged у65 years with pneumococcal vaccine both received a score of out of 10 (ie, highly cost-effective and can prevent a significant health burden) [1] Systematic weighting of the quality of evidence and the grade of recommendation are explained in Table ever any components of the combination are indicated, other components are not contraindicated, and if the vaccine is licensed by the US Food and Drug Administration (FDA) for that dose of the series (A-I) Immunization requirements for childcare, school and college attendance, and nursing homes should be followed (A-II) Vaccine delivery should be coordinated with other preventive health care services for children, adolescents, and adults (B-III) All vaccines should be stored and administered as recommended by the manufacturer and as licensed by the FDA (B-II) II Immunization Standards, Overcoming Barriers to Immunization, Vaccine Safety, Misconceptions, Finances, Access, and Strategies to Improve Coverage Infants, children, adolescents, and adults should receive all age-appropriate vaccines recommended by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics (A-I) Any vaccine dose not administered at the recommended age should be administered at any subsequent medical encounter when indicated and feasible without reinitiating the series (A-III) Recommendations for the minimum interval between doses for people who have delayed immunizations or who want to accelerate their schedule should be followed (B-III) When appropriate, all indicated vaccines should be administered simultaneously (B-III) Licensed combination vaccines can be administered when- Health care providers should determine and follow valid vaccine contraindications and precautions before administration of any vaccine (B-III) 10 Health care providers should be aware of the National Vaccine Injury Compensation Program (NVICP) and its requirements (B-III) 11 All patients or parents should receive Vaccine Information Statements (VISs) for each vaccine administered as required by law for vaccines covered by the NVICP (C-III) 12 Providers should educate their patients and parents about the benefits, safety, and risks of vaccines in a culturally appropriate and easy-to-understand language prior to each immunization (C-III) 13 Clinically significant adverse events following immuni- Table Baseline 20th Century Annual Morbidity, 2007 Morbidity, and Morbidity Decrease for 10 Infectious Diseases with Vaccines Recommended before 1990 for Universal Use in Children in the United States, as Well as Health People 2010 Vaccine Coverage Goals and 2007 Vaccine Coverage Annual morbidity, no of cases Disease 20th century 2007 Morbidity decrease, % Healthy People 2010 Coverage Goala Vaccine coverage in 2007, % Diphtheria Measles 21,053 530,217 43 100 99.9 doses, у90% dose, у90% 85 93 Mumps Pertussis 162,344 200,752 800 10,454 99.5 94.8 dose, у90% doses, у90% 93 85 Polio (paralytic) 16,316 100 doses, у90% 92 Rubella Congenital rubella syndrome Smallpox 47,745 152 29,005 12 0 99.9 99.3 100 dose, у90% dose, у90% … 93 … … 580 28 95.2 doses, у90% 85 20,000 202 99 у3 doses, у90% 94 Tetanus Haemophilus influenzae (type b and unknown; !5 years) NOTE Adapted from [5, 6] a For 19–35-month-old children 818 • CID 2009:49 (15 September) • Pickering et al Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 I Vaccine Recommendations for Infants, Children, Adolescents, and Adults Table Definition of Quality of Evidence and Strength of Recommendation Assessment Strength of recommendation Grade A Grade B Grade C Quality of evidence Level I Level II Level III Type of evidence Good evidence to support a recommendation for use Moderate evidence to support a recommendation for use Poor evidence to support a recommendation Evidence from at least properly designed randomized, controlled trial Evidence from at least well-designed clinical trial, without randomization; from cohort or case-controlled analytic studies (preferably from 11 center); from multiple time series; or from dramatic results of uncontrolled experiments Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees NOTE Adapted from the Canadian Task Force on the Periodic Health Examination [8] Finance 14 Patient out-of-pocket immunization expenses should be minimized (A-I) 15 Vaccine-financing programs, including the Vaccines for Children (VFC) program, Section 317 of the Public Health Service Act federal grant program, state programs, and private insurance, should be optimized for each patient, as appropriate (B-II) 16 Providers who serve infants, children, and adolescents aged !19 years should be enrolled in the VFC program (B-II) 17 Providers should be aware of other government supported and other funded programs that cover the cost of vaccines and their administration for people who not have adequate resources (C-III) Access to Immunizations 18 Barriers to immunizations should be identified and eliminated or as minimized as possible (B-II) 19 Immunization services should be easy to access, including express immunization services (eg, influenza immunization clinics) and expanded hours of immunization services (A-II) 20 Immunization should be integrated into routine health care services offered in offices and clinics (C-III) 21 Private providers should consider participating in programs that provide financially vulnerable adults with access to immunizations at no cost (C-III) Strategies to Improve Immunization Coverage 22 Reminder/recall systems should be used to enhance immunization rates (A-I) 23 Information regarding administration of vaccines should be entered into immunization information systems (ie, immunization registries) (B-III) 24 Standing orders for immunizations should be established in clinics, hospitals, and nursing homes (A-I) 25 The immunization status of patients should be reviewed at each patient visit (B-II), and patients and parents should be provided with accurate immunization records at office or clinic visits (B-III) 26 All health care providers who administer vaccines should be properly educated and should receive ongoing education (A-III) 27 Regular assessments of immunization coverage rates should be conducted in provider practices (A-I) 28 Demand for adolescent and adult immunization should be increased by improving public and provider awareness of immunizations recommended for adolescents and adults (B-III) III Complementary (Nontraditional) Immunization Settings 29 Providers should support use of community-based settings to immunize target populations that have difficulty accessing usual immunization providers (B-III) 30 Providers should support establishment of school-based, childcare-based, and hospital-based immunization programs to deliver influenza immunization to school-aged children, adolescents, and adults (B-III) 31 Immunization providers in complementary settings should adhere to quality standards, including ability to appropriately manage vaccine-related adverse events, proper storage and handling of vaccines, appropriate record keeping, regulatory issues, and provision of education regarding both risks IDSA Immunization Guidelines • CID 2009:49 (15 September) • 819 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 zation should be reported to the Vaccine Adverse Events Reporting System (VAERS) (B-III) and benefits of immunizations, as well as other preventive care measures, including adherence to hand hygiene (B-III) 32 Providers of immunizations in nontraditional settings should ensure that records of immunizations administered in these settings are sent to primary care providers and to immunization information systems (registries) and should encourage vaccinees in such settings to see their primary care providers for other preventive and therapeutic services (B-III) IV Immunization of Specific Groups Immunocompromised Persons 35 All immunocompromised infants, children, adolescents, and adults should be appropriately immunized (B-II) 36 Providers should be aware of contraindications and precautions for vaccines in people with primary and secondary immunodeficiencies (B-III) 37 Providers should educate immunocompromised patients that, depending on the vaccine and their degree of immune dysfunction, the vaccines that are administered may not be fully effective (C-III) 38 Providers who care for immunocompromised patients should ensure that household contacts are immunized appropriately to reduce the risk of exposure of immunocompromised patients to vaccine-preventable diseases (B-III) Pregnancy 39 Providers should be aware of immunizations routinely recommended for women during pregnancy, including inactivated trivalent influenza vaccine (A-II) 40 Providers should administer appropriate vaccines to pregnant women with medical or exposure indications that put them at risk of certain vaccine-preventable diseases (A-I) 41 Following delivery, women should receive all recommended vaccines that could not be or were not administered during pregnancy (A-II) 42 Providers should be aware of and follow valid contra820 • CID 2009:49 (15 September) • Pickering et al International Travel 43 Providers who care for people who travel should ensure that all country-specific vaccines are administered in a time frame that ensures optimal development of protection (A-I) 44 Health care professionals should be aware of key sources of information regarding immunization of travelers at every age (B-III) Internationally Adopted Children 45 Providers should accept only written documentation as evidence of previous immunization (B-III) 46 Providers should be aware of the various approaches that can be followed if there is concern about whether vaccines administered to an international adoptee were immunogenic (B-III) INTRODUCTION In 2002, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline for quality standards for immunization [9] The IDSA updates its guidelines when new data or publications change prior recommendations or when the Expert Panel decides that clarification or additional guidance is warranted For the 2009 guidelines, vaccine licensure, approval, recommendations, safety, financing, barriers, and implementation issues were reviewed This report does not include issues involving vaccines and autism and other potential adverse events The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health commissioned the National Academy of Sciences’ Institute of Medicine to convene an Immunization Safety Review Committee in 2000 This committee, comprising 15 members with diverse expertise, was charged with providing independent advice to vaccine policy makers and to health care professionals, the public, and the media The committee reviewed the scientific plausibility of possible causal associations between vaccines and various adverse events The committee reviewed the following specific topics about existing and emerging vaccine safety concerns: measles-mumps-rubella vaccine and autism (April 2001); thimerosal-containing vaccines and neurodevelopmental disorders (October 2001); multiple immunizations and immune dysfunction (February 2002); hepatitis B vaccine and demyelinating neurologic disorders (May 2002): SV40 contamination of polio vaccine and cancer (October 2002); vaccinations and sudden unexpected death in infancy (March 2003); influenza vaccines and neurologic complications (October 2003); and vaccines and autism (May 2004) For each topic, the committee found the evidence to be inconclusive or in favor of rejection of causal associations be- Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Health Care Professionals 33 All health care professionals should be immunized appropriately (B-II) Specifically, annual immunization with influenza vaccine and receipt of a booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) should be ensured, as well as adequate immunization against measles, mumps, rubella, and varicella People whose work anticipates they may be exposed to blood or body fluids should be immunized against hepatitis B 34 Hospitals, clinics, and offices should implement programs to ensure that health care professionals are immunized appropriately and that annual immunization coverage assessments are performed (B-II) indications and precautions for immunizing pregnant women (A-III) tween vaccines and the adverse events reviewed The committee did not recommend a policy review of the childhood and adolescent immunization schedule or of recommendations for administration of routine childhood vaccines Executive summaries of each of the committee’s reports are available online at http://www.iom.edu/imsafety Except where indicated in the text, these guidelines are provided by the IDSA for health care professionals to ensure appropriate and timely administration of recommended immunizations to infants, children, adolescents, and adults The Expert Panel addressed the following clinical questions (objectives) in this update PRACTICE GUIDELINES Practice guidelines are systematically developed statements to assist health care professionals, patients, and payers in making decisions about appropriate health care for specific clinical circumstances Attributes of high-quality guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process, review of evidence, and documentation [10] METHODS Expert Panel composition The IDSA Standards and Practice Guidelines Committee (SPGC) convened experts in the field of vaccinology from the United States Panel members had experience in pediatric and adult clinical and laboratory medicine, nursing, public health, and infectious diseases and included representatives from the following collaborating organizations: American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American Medical Association (AMA), American Osteopathic Association, CDC, National Association of Pediatric Nurse Practitioners, National Vaccine Advisory Committee of the Department of Health and Human Services, and the Pediatric Infectious Diseases Society Panel members and their affiliations are listed at the end of the text Literature review and analysis For the 2009 update, the IDSA Immunization Guidelines • CID 2009:49 (15 September) • 821 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 What are the current immunization recommendations for infants, children, adolescents, and adults? What are the current immunization standards, and how they contribute to overcoming barriers to immunization and address vaccine safety, misconceptions, finance, access, and strategies to improve coverage? How is immunization implemented in complementary (nontraditional) settings? What are the current immunization recommendations for special groups, including health care professionals, immunocompromised people, pregnant women, international travelers, and internationally adopted children? Expert Panel reviewed data published since 2000 and literature referenced in the 2002 guidelines Computerized literature searches of the PubMed database were performed using the terms immunization, vaccination, and vaccines Only Englishlanguage literature was reviewed The review focused on human studies Process overview In evaluating evidence regarding management of immunizations, the Expert Panel followed a process used in development of other IDSA guidelines The process included a systematic weighting of the quality of evidence and the grade of recommendation (Table 2) Consensus development based on evidence The entire Expert Panel met on occasions via teleconference to initiate and complete the guidelines The purposes of the teleconferences were to discuss and formalize the questions (objectives) to be addressed, designate writing assignments, review draft guidelines, and obtain input about external review All members of the Expert Panel participated in preparation of the draft guidelines, which were then disseminated for review by the entire Expert Panel Feedback from external reviewers also was solicited (see the Acknowledgements) All collaborating organizations were asked to provide feedback and endorse the guidelines These guidelines were reviewed and cleared by the CDC, are supported by the AMA, and have been endorsed by the following organizations: the AAP, the National Association of Pediatric Nurse Practitioners, and the Pediatric Infectious Diseases Society The content of the guidelines and the manuscript were reviewed and approved by the IDSA SPGC and by the Board of Directors before dissemination Guidelines and conflict of interest All members of the Expert Panel complied with the IDSA policy on conflicts of interest, which requires disclosure of any financial or other interest that might be construed as constituting an actual, potential, or apparent conflict Members of the Expert Panel were provided the IDSA conflict of interest disclosure statement and were asked to identify links to companies developing products that might be affected by promulgation of the guidelines Information was requested regarding employment, consultancies, stock ownership, honoraria, research funding, expert testimony, and membership on company advisory committees The Expert Panel made decisions on a case-by-case basis as to whether an individual’s role should be limited as a result of a conflict No limiting conflicts were identified Revision dates At annual intervals, the Expert Panel Chairs, the SPGC liaison advisor, and the Chair of the SPGC will determine the need for revisions to the guidelines on the basis of an examination of current literature If necessary, the Expert Panel will be reconvened to discuss potential changes When appropriate, the Expert Panel will recommend revision of the guideline to the SPGC and the IDSA Board of Directors for review and approval RESULTS OF THE LITERATURE SEARCH Types of studies evaluated included randomized, clinical trials; cohort and case-control analytic studies; and the results of uncontrolled studies Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, and reports of expert advisory committees also were considered Specifically, we considered the recommendations of the AAFP; the AAP; the ACOG; the Advisory Committee on Immunization Practices (ACIP); the ACP; the National Vaccine Advisory Committee, including the Standards for Child and Adolescent Immunization Practices and the Standards for Adult Immunization; the Task Force on Community Preventive Services; and the National Vaccine Injury Compensation Program Expert Panel members were assigned sections of the guidelines to prepare with the final document reviewed and approved by all members I WHAT ARE THE CURRENT IMMUNIZATION RECOMMENDATIONS FOR INFANTS, CHILDREN, ADOLESCENTS, AND ADULTS? Recommendations Infants, children, adolescents, and adults should receive all age-appropriate vaccines recommended by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics (A-I) Any vaccine dose not administered at the recommended age should be administered at any subsequent medical encounter when indicated and feasible without reinitiating the series (A-III) Recommendations for the minimum interval between doses for people who have delayed immunizations or who want to accelerate their schedule should be followed (B-III) When appropriate, all indicated vaccines should be administered simultaneously (B-III) Licensed combination vaccines can be administered whenever any components of the combination are indicated, other components are not contraindicated, and if the vaccine is licensed by the US Food and Drug Administration (FDA) for that dose of the series (A-I) Immunization requirements for childcare, school and college attendance, and nursing homes should be followed (A-II) Vaccine delivery should be coordinated with other preventive health care services for children, adolescents, and adults (B-III) All vaccines should be stored and administered as rec822 • CID 2009:49 (15 September) • Pickering et al Evidence summary Evidence-based recommendations for use of each vaccine licensed by the FDA for the civilian population in the United States are made by the ACIP with input from professional partner organizations (http://www.cdc.gov/ vaccines/recs/acip/default.htm) In addition, the Committee on Infectious Diseases of the AAP makes policy recommendations for vaccines licensed by the FDA for use in infants, children, and adolescents Recommendations of the ACIP are considered to be official following approval by the Director of the CDC, and recommendations of the AAFP, AAP, and ACP are considered to be official after approval by the AAFP and AAP boards of directors and ACP Board of Regents In addition to the 15 appointed members of the ACIP, input on immunization recommendations are provided by 26 liaison and ex officio organizations, which include representation from major medical societies, managed care organizations, government agencies, and others Once per year, the AAFP, AAP, and ACIP issue a harmonized childhood and adolescent immunization schedule, which is available online (http://www.cdc.gov/vaccines/recs/schedules/ default.htm#child) and is published in The Morbidity and Mortality Weekly Report, Pediatrics, and American Family Physician In addition, the AAFP, ACIP, ACOG, and ACP annually issue a harmonized adult immunization schedule, which can be found online (http://www.cdc.gov/vaccines/recs/schedules/ default.htm) and is published in American Family Physician, Annals of Internal Medicine, and The Morbidity and Mortality Weekly Report In the time between annual publications of the immunization schedules, additions and changes to schedules are published as Notices to Readers in The Morbidity and Mortality Weekly Report and subsequently incorporated into the next annual published schedules Health care professionals should ensure that the most current schedules are followed and should adhere as closely as possible to the most current recommended immunization schedule For a variety of reasons, infants, children, adolescents, and adults often fall behind on receipt of recommended immunizations [11] Because the goal of administering vaccines is to prevent disease, children and adults who are not current with recommended immunizations should be immunized as soon as possible, before exposure to a potentially infectious organism Licensure of vaccines by the FDA and recommendations for the age(s) at which vaccines are administered are influenced by age-specific risks for disease acquisition, age-specific risks for complications, ability to respond to a vaccine, and in infants, potential interference with the immune response by passively transferred maternal antibody as well as immunologic immaturity Several vaccines, including those that are inactivated, toxoids, polysaccharide conjugates, and recombinant subunits, Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 GUIDELINE RECOMMENDATIONS FOR IMMUNIZATION OF INFANTS, CHILDREN, ADOLESCENTS, AND ADULTS ommended by the manufacturer and as licensed by the FDA (B-II) ministering different combinations of live and inactivated vaccines has resulted in seroconversion rates similar to rates observed when the vaccines are administered separately [22] Use of combination vaccines can reduce the number of injections required Licensed combination vaccines can be used whenever any components contained in the vaccine are indicated, if its other components are not contraindicated, and if the vaccine is licensed by the FDA for that dose in the series [24, 25] Laws requiring immunization for school or child care attendance are a safety net for the immunization program in the United States [26] All 50 states and the District of Columbia have school and child care immunization laws in effect that vary by state (http://www.immunize.org/laws or http://www cdc.gov/other.htm#states/) These laws have resulted in decreased incidence of measles, mumps, and pertussis in states with laws, compared with states without laws [26–28] Regulations also have proven effective in protecting college students from vaccine-preventable diseases [29] These laws improve compliance with recommendations and enable achievement of herd protection for people who cannot be immunized because of medical indications or who not respond to vaccine Children who are not appropriately immunized are not permitted to attend school or child care, although most states allow exemptions for medical and religious objections to immunization [30]; a number of states allow personal belief exemptions In situations where parents refuse vaccines for their child, and if a medical contraindication for receipt of vaccines does not exist, the child’s physician should document that the parents have been informed about risks and benefits of vaccines A document for this purpose is available from the AAP (http://practice aap.org/content.aspx?aidp1605&nodeIDp3014) Research has demonstrated that providing quality, evidencebased preventive care is important in helping people live healthy lives Delivery of many evidence-based preventive services is suboptimal because of limited clinician time, the large number of recommendations, and the difficulty of integrating many preventive service recommendations into health care visits because of many competing demands [31] Health care providers, health insurance plans, employers, and consumers all need information about preventive services that produce the greatest benefit and return on investment, to be able to target them for enhancing utilization rates The National Commission on Prevention Priorities provided a ranking of 25 clinical services meeting the study’s inclusion criteria [1] Services were scored by clinically preventable burden and cost-effectiveness Only services received the highest score of 10: discussing aspirin use for prevention of cardiovascular events in high-risk adults, tobacco-use screening and intervention, and immunization of children Ninety percent or more of children in the United States receive most of the imIDSA Immunization Guidelines • CID 2009:49 (15 September) • 823 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 require administration of у2 doses for development of an appropriate and persisting immune response [12–17] With the exception of zoster and yellow fever vaccines, protection using attenuated, live viral vaccines requires 11 dose [18–20], and protection against influenza requires annual immunization [21] For people aged months through 18 years, a printed catchup schedule is available for infants, children, and adolescents who begin late or who are 11 month behind on receipt of immunizations For children from birth through years of age, an interactive computer-based program is available to assist with catch-up (http://www.cdc.gov/vaccines/scheduler/catchup htm) For adults who are behind on their immunizations, recommendations for individual vaccines on the adult immunization schedule should be consulted A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses and regardless of vaccine type [22] In some circumstances, a vaccine that requires multiple doses may need to be administered at shorter intervals than those customarily used This may occur if a person is behind schedule and needs to become current with recommended vaccines quickly or if international travel is imminent In these situations, an accelerated schedule can be used The catch-up immunization table for people aged months through 18 years and the computer program for children from birth through years of age not only provide a catch-up schedule but also minimum intervals between doses for children whose immunizations have been delayed or for patients or parents who want to accelerate a schedule There are no data to support administration of vaccines at intervals less than these minimum intervals or earlier than the minimum age An exception is during a measles outbreak when measles cases are occurring among infants aged !12 months In this instance, measles immunization of infants as young as months of age can be performed as part of outbreak control Doses of measles-containing vaccine administered to infants aged !12 months should not be counted as part of the recommended immunization series [22] The ACIP recommends that vaccine doses administered р4 days before the minimum interval or age be counted as valid [22] Doses administered у5 days before the minimum age should be repeated on or after the child reaches the minimum age and у4 weeks after the invalid dose If 11 vaccine is recommended to be administered at a specific age, vaccines should be administered at the same visit at separate injection sites Simultaneously administering all vaccines to a person who is eligible is important, because simultaneous administration increases the probability that a child or adult will be appropriately immunized [23] Simultaneous administration is often critical when preparing for foreign travel and if uncertainty exists as to whether a person will return for additionally recommended vaccine doses Simultaneously ad- II WHAT ARE THE CURRENT IMMUNIZATION STANDARDS, AND HOW DO THEY CONTRIBUTE TO OVERCOMING BARRIERS TO IMMUNIZATION AND ADDRESS VACCINE SAFETY MISCONCEPTIONS, FINANCE, , ACCESS, AND STRATEGIES TO IMPROVE COVERAGE? Recommendations Health care providers should determine and follow valid vaccine contraindications and precautions before administration of any vaccine (B-III) 10 Health care providers should be aware of the NVICP and its requirements (B-III) 11 All patients or parents should receive VISs for each vaccine administered as required by law for vaccines covered by the NVICP (C-III) 12 Providers should educate their patients and parents about the benefits, safety, and risks of vaccines in a culturally appropriate and easy-to-understand language prior to each immunization (C-III) 824 • CID 2009:49 (15 September) • Pickering et al 13 Clinically significant adverse events following immunization should be reported to the VAERS (B-III) Evidence summary Observation of valid contraindications and precautions is critical to assure that vaccines are used as recommended to obtain optimal safety A contraindication means the vaccine should not be administered under any circumstance A generic contraindication for all vaccines is prior anaphylactic reaction to a vaccine or a vaccine constituent A precaution does not preclude vaccine administration, but the events or conditions listed as a precaution should be reviewed carefully before vaccine administration (http://www.cdc.gov/ vaccines/recs/vac-admin/contraindications.htm) Anaphylaxis has been demonstrated to occur on rare occasions to certain vaccines, and immunoglobulin E–mediated immune responses to some vaccine components have been demonstrated, including gelatin contained in some vaccines If a person with a history of anaphylaxis to a vaccine or component of the vaccine is given the vaccine inappropriately, then anaphylaxis may recur On some occasions, disseminated infection with vaccine virus has occurred, with serious consequences, in persons who are severely immunocompromised and who receive a live viral vaccine Such outcomes have included vaccine-associated paralytic poliomyelitis following administration of oral polio virus vaccine and measles-associated encephalitis in patients with congenital immunodeficiencies who have received a measles virus–containing vaccine [33] If invalid contraindications are used, then immunization rates can suffer Studies have found missed opportunities for immunization in primary care, and surveys have shown that some providers report being overly cautious when interpreting contraindications Immunization rates and immunization timeliness of a practice are correlated with physician-reported beliefs about vaccine contraindications [34–37] Prior to enactment of the National Childhood Vaccine Injury Act (NCVIA) in 1986, there had been a large increase in litigation against manufacturers, primarily related to diphtheria, tetanus, and whole-cell pertussis vaccine (DTP) [38] Major grounds for litigation involving DTP and oral polio vaccines were allegations that the manufacturers had not fulfilled their obligations regarding the duty to warn prospective vaccine recipients and/or their guardians about risks and benefits of the vaccines The NCVIA accepted the duty to warn as a federal responsibility and required development of VISs for all covered vaccines The CDC oversees creation and modification of the VISs Federal law requires that all vaccine providers give the appropriate VIS to prospective vaccine recipients or their guardians prior to each dose of vaccine [39] Although as of 2009, all vaccines universally recommended for children or adolescents are covered by the NVICP, VISs also are available for a variety of vaccines that are not covered by the NVICP All VISs can be found at http://www.cdc.gov/vaccines/pubs/ Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 munizations recommended annually for preschool children (http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm) The proportion is even higher for school-aged children receiving immunizations mandated for school attendance Other services receiving a score of from the Commission were pneumococcal immunization of adults aged у65 years and annual influenza immunization of adults aged у50 years The AAFP, AAP, ACP, AMA, and CDC all recommend preventive health services at all life stages during regularly scheduled preventive care visits Professional organizations emphasize the importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care When possible, immunizations, along with other preventive care measures, should be delivered in a medical home environment [32] When the FDA licenses a vaccine, recommendations are made regarding storage, handling, and administration Failure to adhere to recommended specifications for storage and handling of immunobiologics can reduce their potency and result in an inadequate immune response Each vaccine package insert contains recommendations about methods for reconstitution of the vaccine All vaccines should be inspected upon delivery and monitored during storage to ensure adherence to the cold chain Information about appropriate storage temperature, temperature monitoring, response to out-of-temperature range storage, and expiration date is contained in package inserts and can be found online (http://www.cdc.gov/vaccines/recs/storage/ default.htm) All FDA-licensed vaccines have a preferred route of administration, which is specified in the package insert and in ACIP and professional society recommendations [22] Finance Recommendations 14 Patient out-of-pocket immunization expenses should be minimized (A-I) 15 Vaccine-financing programs, including the VFC program, Section 317 of the Public Health Service Act federal grant program, state programs, and private insurance, should be optimized for each patient, as appropriate (B-II) 16 Providers who serve infants, children, and adolescents aged !19 years should be enrolled in the VFC program (B-II) 17 Providers should be aware of other government supported and other funded programs that cover the cost of vaccines and their administration for people who not have adequate resources (C-III) Evidence summary The Task Force on Community Preventive Services reviewed the evidence of effectiveness of reducing out-of-pocket costs at increasing immunization coverage levels among children, adolescents, and adults [41] Reducing outof-pocket costs for immunizations can be accomplished by providing free immunizations, reducing administrative costs associated with immunizations, providing insurance coverage, or reducing co-payments for immunizations at the point of service The Task Force found 19 high-quality studies that demonstrated a median coverage improvement of 10% for interventions that only reduced cost and an improvement of 16% when a cost-reduction intervention was coupled with another active intervention such as reminder/recall [48] Optimizing the use of government funding sources or private insurance for individual patients is considered a mechanism of providing free or reduced cost vaccine and is within the scope of the Task Force evidence review The VFC program has been shown to improve access to childhood and adolescent immunizations by reducing referrals for immunization from the medical home (http://www.cdc gov/vaccines/programs/vfc/default.htm) Reducing referrals reduces missed opportunities to vaccinate A survey of 1236 physicians showed that, among physicians who received free immunization supplies from the VFC program or elsewhere, 44% were likely to refer an uninsured child, whereas 90% of those not receiving free immunization were likely to refer an uninsured child (P ! 001) [49] The National Vaccine Advisory Committee developed the Standards for Child and Adolescent Immunization Practices and the Standards for Adult Immunization Practices [23, 50] The standards recommended by this committee of experts included that providers practice community-based approaches to immunization services (Tables and 4) Community-based approaches may involve working with partners in the community, including public health departments, managed care organizations, and other service providers, to determine community IDSA Immunization Guidelines • CID 2009:49 (15 September) • 825 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 default.htm#vis The NCVIA has offered substantial protection to providers against litigation related to vaccine administration [39, 40] Families who feel that their child was injured by a vaccine can request compensation from NVICP Information on how to file a VICP claim is available at http://www.hrsa gov/vaccinecompensation or by telephone at 1-800-338-2382 Providers have a responsibility to educate their patients or parents/guardians prior to a procedure, including immunizations The VIS is a helpful source of information The actual effectiveness of the VIS in communicating vaccine risks and benefits is unclear, in part because it is not known how many people actually read them Each VIS is written in easy to understand language (http://www.cdc.gov/vaccines/pubs/vis/default.htm) There are VISs available for individual vaccines or as a multiple vaccines document that may be used as an optional substitute for any or all of the VISs that cover vaccines recommended routinely for children from birth through months of age (DTaP, inactivated polio vaccine [IPV], Haemophilus influenzae type b [Hib], pneumococcal conjugate vaccine [PCV], hepatitis B [HepB], and rotavirus [RV]) The Task Force on Community Preventive Services recommends multicomponent interventions to increase community demand that include education (http://www.thecommunityguide.org/vaccine/vpd-int-demand -multicomponent-ed.pdf) [41] The NCVIA requires immunization providers to report all adverse events that would contraindicate further doses of a covered immunization as well as all adverse events meeting the criteria for an injury specified in a table maintained by the NVICP Reports should be made to the VAERS Reporting forms can be obtained by calling 1-800-822-7967 or by visiting http://www.vaers.hhs.gov The VAERS system generally is not useful in determining whether temporally related adverse events are related causally to vaccines [42] However, VAERS is important in identifying potential signals of adverse events that require further investigation For example, reports of intussusception among infants receiving the rhesus rotavirus tetravalent vaccine, with onsets clustering 3–5 days after receipt of the first dose, suggested the vaccine could cause intussusception [43] Furthermore, more comprehensive investigations confirmed the causal association, and the use of this vaccine was discontinued [44, 45] Thus, VAERS reports led to a policy change due to a newly recognized but rare adverse effect that was not established before vaccine licensure Passive reporting of adverse events suggested meningococcal conjugate (MCV4) vaccine may be related causally to Guillain-Barre syndrome, ´ although extremely rarely [46] This led to a formal case-control study, the preliminary results of which not support a causal link [47] VAERS is the only system that has the potential to collect adverse event data for every vaccine dose administered in the United States Table Standards for Child and Adolescent Immunization Practices Availability of vaccines Immunization services are readily available Immunizations are coordinated with other health care services and provided in a Medical Home, when possible Barriers to immunization are identified and minimized Patient costs are minimized Assessment of immunization status Health care professionals review the immunization and health status of patients at every encounter to determine which vaccines are indicated Health care professionals assess for and follow only medically accepted contraindications Effective communication about vaccine benefits and risks Parents or guardians and patients are educated about the benefits and risks of immunization in a culturally appropriate manner and in easy-to-understand language Proper storage and administration of vaccines and documentation of immunizations Health care professionals follow appropriate procedures for vaccine storage and handling Up-to-date, written immunization protocols are accessible at all locations where vaccines are administered NOTE Reproduced with permission from [23] needs and to develop immunization services that address these needs Access to Immunizations Recommendations 18 Barriers to immunizations should be identified and eliminated or as minimized as possible (B-II) 19 Immunization services should be easy to access, including express immunization services (eg, influenza immunization clinics) and expanded hours of immunization services (A-II) 20 Immunization should be integrated into routine health care services offered in offices and clinics (C-III) 21 Private providers should consider participating in programs that provide financially vulnerable adults with access to immunizations at no cost (C-III) Evidence summary The Standards for Child and Adolescent Immunization Practices were designed to lower barriers to immunization services for children and adolescents The Standards include assuring that immunization services are readily 826 • CID 2009:49 (15 September) • Pickering et al available and coupled with other routine clinical services, lowering barriers to immunizations, reducing out-of-pocket costs to patients and parents, and communicating effectively the benefits and risks of immunization (Table 3) [23] A 1-year nonrandomized trial conducted in 1995 in New Mexico compared health care settings: a control setting and a setting in which the Standards were implemented Immunization coverage levels at the intervention site increased from 58% to 80%, whereas coverage levels remained static at 42% in the control setting In addition, completion of a 4-dose immunization series increased substantially in the standards group, compared with the control group [51] The Task Force on Community Preventive Services identified 16 high-quality studies on expanding access to immunization services Most of these studies combined expansion of access with another intervention including provider education, reducing costs, and reminder/recall The types of expanded access tested included drop-in clinics, increasing hours to include nights and weekends, dedicated immunization clinics, and transportation assistance The median impact of these Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Persons who administer vaccines and staff who manage or support vaccine administration are knowledgeable and receive ongoing education Health care professionals simultaneously administer as many indicated vaccine doses as possible Immunization records for patients are accurate, complete, and easily accessible Health care professionals report adverse events following immunization promptly and accurately to the Vaccine Adverse Event Reporting System and are aware of a separate program, the National Vaccine Injury Compensation Program All personnel who have contact with patients are appropriately vaccinated Implementation of strategies to improve immunization coverage Systems are used to remind parents or guardians, patients, and health care professionals when immunizations are due and to re-call persons who are overdue Office- or clinic-based patient record reviews and immunization coverage assessments are performed annually Health care professionals practice community-based approaches Table Standards for Adult Immunization Practices Make immunizations available Adult immunization services are readily available Barriers to receiving vaccines are identified and minimized Patient “out-of-pocket” immunization costs are minimized Assess patients’ immunization status Health care professionals routinely review the immunization status of patients Health care professionals assess for valid contraindications Communicate effectively with patients Patients are educated about risks and benefits of immunization in easy-to-understand language Administer and document immunizations properly Written immunization protocols are available at all locations where vaccines are administered Persons who administer vaccines are properly trained Health care professionals recommend simultaneous administration of indicated vaccine doses Immunization records for patients are accurate and easily accessible All personnel who have contact with patients are appropriately vaccinated Implement strategies to improve immunization rates Systems are developed and used to remind patients and health care professionals when immunizations are due and to re-call patients who are overdue NOTE Reproduced with permission from [50] expanded access interventions was a 13% improvement in coverage Updated and detailed information on the Task Force evidence summaries of barrier-reduction interventions can be found at http://www.thecommunityguide.org Strategies to Improve Immunization Coverage Recommendations 22 Reminder/recall systems should be used to enhance immunization rates (A-I) 23 Information regarding administration of vaccines should be entered into immunization information systems (ie, immunization registries) (B-III) 24 Standing orders for immunizations should be established in clinics, hospitals, and nursing homes (A-I) 25 The immunization status of patients should be reviewed at each patient visit (B-II), and patients and parents should be provided with accurate immunization records at office or clinic visits (B-III) 26 All health care providers who administer vaccines should be properly educated and should receive ongoing education (A-III) 27 Regular assessments of immunization coverage rates should be conducted in provider practices (A-I) 28 Demand for adolescent and adult immunization should be increased by improving public and provider awareness of immunizations recommended for adolescents and adults (B-III) Evidence summary The Task Force on Community Preventive Services reviewed the evidence of effectiveness of reminder/ recall systems, which remind a provider that a specific immunization is due (reminder) or overdue (recall) The content and the methods used to deliver reminders varied among studies in the systematic review The Task Force reviewed studies containing a total of 17 intervention arms that used reminder/ recall alone and 12 intervention arms that used reminder/recall in conjunction with other interventions The median improvements in immunization coverage were 17% and 14%, respectively [48] The Task Force and a Cochrane Database review concluded that strong evidence exists that reminder/recall systems improve coverage for routinely recommended immunizations for children, adolescents, and adults [41, 52], but reminder/recall messages are underused by pediatricians and public health clinics [53] Immunization information systems are confidential, computerized information systems that contain information about immunizations The National Vaccine Advisory Committee reviewed the nation’s progress on implementing immunization information systems and made recommendations to enhance access to immunization information systems The National Vaccine Advisory Committee recommended that all immunization providers should participate in an immunization inforIDSA Immunization Guidelines • CID 2009:49 (15 September) • 827 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Standing orders for immunizations are employed Regular assessments of immunization coverage levels are conducted in a provider’s practice Partner with the community Patient oriented and community based 828 • CID 2009:49 (15 September) • Pickering et al that provider assessment and feedback increase immunization provision across a wide range of providers and contexts More information on the details of this intervention can be found at http://www.thecommunityguide.org The National Vaccine Advisory Committee made a number of recommendations to sustain the success of childhood immunizations in the United States [23] Among the recommendations of this expert committee are that parents should be supported in their efforts to immunize their children and that public awareness campaigns to improve parents’ knowledge about the importance and safety of immunizations should be sustained and/or initiated, particularly in underserved areas III HOW IS IMMUNIZATION IMPLEMENTED IN COMPLEMENTARY (NONTRADITIONAL) IMMUNIZATION SETTINGS? Recommendations 29 Providers should support use of community-based settings to immunize target populations that have difficulty accessing usual immunization providers (B-III) 30 Providers should support establishment of school-based, childcare-based, and hospital-based immunization programs to deliver influenza immunization to school-aged children, adolescents, and adults (B-III) 31 Immunization providers in complementary settings should adhere to quality standards, including ability to appropriately manage vaccine-related adverse events, proper storage and handling of vaccines, appropriate record keeping, regulatory issues, and provision of education regarding both risks and benefits of immunizations, as well as other preventive care measures, including adherence to hand hygiene (B-III) 32 Providers of immunizations in nontraditional settings should ensure that records of immunizations administered in these settings are sent to primary care providers and to immunization information systems (registries) and should encourage vaccinees in such settings to see their primary care providers for other preventive and therapeutic services (B-III) Evidence summary Complementary immunization sites are often called “nontraditional immunization sites,” which reflects their existence outside the traditional primary health care setting Such sites complement primary care, particularly for adult and potentially adolescent immunizations, given that many Americans not have a personal health care provider [57] and given that a significant percentage of adult immunizations occur outside the primary care setting [58] In recent years, there has been a substantial increase in immunizations recommended for adolescents including MCV4, Tdap, and doses of human papillomavirus vaccine for females [15–17] Many adolescents not make regular health care visits at times when the vaccines are recommended to be ad- Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 mation system and that all immunization recipients should have their immunizations recorded in an immunization information system [54] Although immunization information systems continue to expand their capacity to collect information on people of all ages, there is a need for sustained efforts to improve participation and to ensure that data quality measures for timeliness and completeness are met [55] A CDC program goal for 2010 is to achieve 195% participation in an immunization information system among children aged !6 years [55] The Task Force on Community Preventive Services reviewed the evidence of effectiveness of standing orders programs to improve immunization coverage levels Standing orders involve programs in which nonphysician medical personnel prescribe or deliver immunizations to clients without direct physician involvement at the time of the visit [56] The Task Force found that standing orders, when used alone, were effective in increasing adult coverage with universally recommended immunizations by a median of 51% (range, 30%–81%) More information on this systematic review can be found at http:// www.thecommunityguide.org The National Vaccine Advisory Committee developed the Standards for Child and Adolescent Immunization Practices and the Standards for Adult Immunization Practices [41, 50] The standards recommended by this committee of experts included that health care professionals should review the immunization and health status of patients at every encounter to determine which immunizations are indicated; that immunization records for patients are accurate, complete, and easily accessible; and that people who administer immunizations and staff who manage or support immunization administration are knowledgeable and receive ongoing education The Task Force on Community Preventive Services reviewed the evidence of effectiveness of assessment of immunization coverage levels at provider offices, coupled with feedback to the provider of their immunization performance The goals of these interventions can include changing the provider’s knowledge, attitudes, and behavior and stimulating other changes in the way immunizations are delivered (eg, using provider reminder/recall systems or standing orders) Assessments can be conducted for providers in private or group practices, managed care organizations, teaching hospitals, or other settings and can be conducted by the provider’s staff, the staff of the organization that manages the setting, insurance companies, or others interested in improving immunization delivery The Task Force found intervention arms that evaluated provider assessment and feedback alone and intervention arms that evaluated multicomponent programs that included provider assessment and feedback The results of these studies showed median improvements in immunization coverage of 16% and 17%, respectively The Task Force concluded that the results indicate motivation of the public to seek immunization in complementary settings These limitations will have to be addressed to optimally utilize complementary settings to assure all people for whom immunizations are recommended can gain ready access to immunization services [62] Racial and ethnic disparities currently exist in immunization coverage rates, particularly for adults, and adolescent immunization remains a challenge in most primary care settings These populations may be served by use of complementary immunization settings For racial and ethnic minorities, community leaders and respected community organizations can play influential roles in promoting immunization Thus, it is important to consider using settings such as churches, community health and social centers, YWCA/YMCA facilities, and places of employment to reach the racial and ethnic minorities not well served by traditional immunization services Hospital-based programs can implement influenza immunization protocols to ensure no one is discharged from the hospital before or during influenza season without receiving immunization The hospital emergency department is another setting in which to reach children, adolescents, and adults with chronic illness who may need influenza vaccine prior to discharge and to use Tdap in place of tetanus and diphtheria vaccine when a tetanus immunization is indicated [63] The use of standing orders or protocols expedites delivery of immunization in this setting [56] The AMA has issued quality standards for store-based clinics (http://www.ama-assn.org/go/policy) The AAP’s policy on retail-based clinics can be found at http://aappolicy aapublications.org/cgi/reprint/pediatrics;118/6/2561.pdf The AAP is committed to the medical home model for medical care for infants, children, and adolescents Pertinent to immunization services delivered in complementary settings are the following: (1) standardized medical protocols derived from evidence-based practice guidelines should be used to ensure patient safety and quality of care; (2) immunization providers should have direct access to and/or protocol oversight by physicians, as consistent with state laws; (3) protocols should be established to ensure continuity of care with practicing physicians within the local community; (4) referral systems should be established for cases beyond the scope of practice of the setting; (5) patients should be informed about the qualifications and limitations of providers giving care; (6) appropriate sanitation and hygienic guidelines should be followed by the facility; (7) electronic health records should be used, when available, as a means of communicating patient information and facilitating continuity of care; and (8) patients should be advised to establish care with a primary care provider to ensure continuity of care and to receive other disease or condition preventive measures The National Vaccine Advisory Committee has issued quality IDSA Immunization Guidelines • CID 2009:49 (15 September) • 829 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 ministered [59], and many not have a medical home where medical care can be consistently provided Thus, provision of immunization services in other places, such as schools, may be necessary to reach this vulnerable age group Thus, complementary settings, such as schools, shopping malls, and pharmacies, and immunization through sports teams should be evaluated [59, 60] By contrast, an estimated 80% of pediatric immunizations occur within the context of primary care practice Complementary sites appear less important for vaccinating children than for older aged people However, even for pediatric immunizations, complementary sites may be needed to reach populations that have poor access to primary care This may be especially true for annual influenza immunization, which should be delivered to all children and adolescents aged months through 18 years each fall or winter Immunizations could be offered at places where parents access other health care services, such as Special Supplemental Nutrition Program for Women, Infants, and Children offices and pharmacies, or in community settings, such as housing projects, schools or school-based clinics, and churches, thereby breaking down barriers to immunization However, the use of such sites will need to be promoted and supported with adequate resources, and their utility will need to be evaluated Proper use of complementary sites for immunization services can provide the following benefits: (1) improving access to immunizations for many adolescents and adults who are otherwise unable to reach a primary care provider; (2) having the potential to eliminate barriers associated with seeking care in a primary care setting, such as making an appointment or long waiting times; (3) providing immunizations at lower costs, which may increase access for the uninsured or for people who have insurance that either does not cover immunizations or is associated with large deductibles or co-payments; and (4) increasing opportunities to raise awareness and educate the public about the value of immunizations In addition, new partnerships and alliances can be formed that can improve immunization outreach; these may be especially important when planning for pandemic influenza Challenges exist to the provision of immunization services outside the primary care setting and include the following: (1) Management of adverse events including syncope [61] that may occur after immunization; all immunization providers must be trained to respond appropriately (2) Assurance that immunization records are available for primary care providers and other vaccinators when patients receive subsequent care; this requires careful record keeping including the use of a registry/ information system (for example, to eliminate unnecessary reimmunization) (3) Legal limitations on who can administer vaccines; many states have legislation regulating which health care professionals can administer immunizations Finally, (4) 830 • CID 2009:49 (15 September) • Pickering et al lematic at all ages and must be acknowledged by the provider in complementary settings [61] For many adolescents and adults, receipt of an immunization may be that person’s only encounter with the health care system Thus, every effort should be made by a complementary immunization provider to make that experience as positive as possible and to refer the patient to a traditional primary care provider where she/he can receive further evaluation for additional preventive and therapeutic medical interventions IV WHAT ARE THE CURRENT IMMUNIZATION RECOMMENDATIONS FOR SPECIAL GROUPS, INCLUDING HEALTH CARE PROVIDERS, IMMUNOCOMPROMISED PEOPLE, PREGNANT WOMEN, INTERNATIONAL TRAVELERS, AND INTERNATIONALLY ADOPTED CHILDREN? Health Care Professionals Recommendations 33 All health care professionals should be immunized appropriately (B-II) Specifically, annual immunization with influenza vaccine and receipt of a booster dose of Tdap should be ensured, as well as adequate immunization against measles, mumps, rubella, and varicella People whose work anticipates they may be exposed to blood or body fluids should be immunized against hepatitis B 34 Hospitals, clinics, and offices should implement programs to ensure that health care professionals are immunized appropriately and that annual immunization coverage assessments are performed (B-II) Evidence summary Occupational activities place health care professionals at increased risk of exposure to communicable diseases through their close contact with patients and with patients’ specimens, body fluids, and excretions These same close contacts make it possible for health care providers to transmit their own communicable diseases to their vulnerable patients Recognizing this, infection control procedures have been established to minimize the risk of infection transmission during provision of medical care Immunization of personnel working in the entire spectrum of health care settings is a fundamental feature of infection control, patient safety programs, and personnel safety Immunization should be a component of the occupational health program of all medical care facilities, including hospitals; physicians’ offices; extended care and nursing facilities; free-standing surgical, radiological, and other units; and clinics of all types All health care professionals and people who work in any health care setting should be included These settings encompass personnel who provide direct patient care (eg, physicians, nurses, dentists, respiratory and physical therapists, phlebotomists, radiology technicians, receptionists, social workers, and chap- Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 standards and guidance specific to adult immunization programs in complementary settings [60] The standards are (1) information and education, such as culturally appropriate materials on the benefits and safety of the vaccine and the provision of vaccine information statements, should be provided to vaccinees; (2) adherence to vaccine handling and storage recommendations included in vaccine package inserts is critical; (3) preimmunization screening interviews should be conducted that include obtaining history of prior immunizations obtained before administering vaccines; (4) immunization providers must assess the presence of contraindications; (5) documentation of the immunization should be kept and recorded in the vaccinee’s medical file, sent to the primary care provider, and given to the vaccinee; documentation includes the date of administration, name of the vaccine, manufacturer and lot number, the administration site, and the provider who gave the immunization and should note that the VIS was provided and discussed with the immunization recipient or parent; (6) providers in complementary settings who administer vaccines must have the legal authority to so and must be appropriately educated and licensed in all aspects of immunization administration; and (7) providers must be educated to recognize and treat adverse events, and the equipment needed to so must be available on site Immunization providers in complementary settings also should be mindful of all of the quality standards required for safe immunization This includes following standard precautions to prevent transmission of infection during immunization, such as proper hand hygiene prior to vaccinating Safety devices for vaccine administration also are recommended for complementary settings It is vital to safely dispose of needles in a hazardous waste container that is puncture proof without manually recapping or detaching the needle from the syringe The use of gloves is not necessary for immunization in any setting, unless the person giving the immunization has open lesions or determines that a potential for exposure to blood or body fluids exists Privacy practices will be challenging in complementary settings Concerns about physical privacy must be met, such as by providing screens for mass influenza immunization clinics in public settings In addition, privacy of health care information must be respected (ie, abiding by all Health Insurance Portability and Accountability Act regulations) As an example, clinic workers should not call out a patient’s first and last name in retail, school, or other public settings Whatever the setting, developmental considerations and age must be considered when vaccinating infants, children, adolescents, and adults All patients must be screened appropriately prior to immunization, and providers in all settings must discuss immunization risks and benefits with patients in an ageappropriate manner Anxiety produced by needles can be prob- in the United States In 2006, imported measles spread to an insufficiently immunized hospital employee [76] The substantial mumps outbreak of 2006 in the midwestern United States demonstrated that not all involved health care professionals had been optimally immunized The CDC now recommends that health care personnel should receive doses of mumps vaccine [19] Varicella also has been transmitted in health care settings and often is introduced into hospitals by children or by medical personnel who were asymptomatic at the end of the incubation period, just before skin lesions erupt [77–80] Patients with herpes zoster also can be the source of transmissible varicella virus, requiring an immune population of health care personnel to prevent nosocomial acquisition Pertussis is resurgent, with the number of reported cases having increased steadily since the 1980s This is thought to be the consequence of immunity waning after childhood vaccination, leaving adolescents and adults only partially protected In this setting, pertussis introductions into health care settings serving both children and adults have become quite common and now often rank among the most frequent infectious disease exposures that require evaluation by occupational health services of hospitals [81–83] The licensure, in 2005, of an acellular pertussis vaccine formulated for use in adolescents and adults (in combination with Tdap) stimulated the CDC to recommend that health care personnel receive a single dose of Tdap as soon as feasible [62, 84] Hepatitis B was once a regular occupational hazard of all health care professionals whose interactions with patients involved exposure to their blood or body fluids, particularly in the context of using a sharp instrument Serosurveys performed in the prevaccine era indicated that health care professionals had 3–5 times the risk of acquiring hepatitis B, compared with the general population [85, 86] In 1991, the Occupational Safety and Health Administration issued regulations that required all health care facilities to provide their employees hepatitis B immunization [87] Consequently, hepatitis B infections among health care professionals have decreased substantially [88] Introduction of influenza into hospitals, nursing homes, and other health care facilities is a well-recognized event Infected medical personnel may introduce influenza into the facility from the community and also may acquire influenza from infected patients and then further transmit infection to patients and other medical staff [89, 90] Influenza also produces substantial absenteeism among personnel, with resultant disruptive impact on the provision of medical care Influenza immunization of health care professionals has been shown to reduce the risk of acquisition of influenza by patients leading also to reduced mortality and has been shown to be cost-saving [91– 94] Influenza vaccine is not only effective in reducing transIDSA Immunization Guidelines • CID 2009:49 (15 September) • 831 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 lains) as well as personnel who work in the health care environment who may not care for patients directly (eg, dietary workers, environmental services, security, and administrative personnel) Included also are emergency medical technicians, contract personnel, volunteers, and students of all disciplines in the health care environment Although many physicians and other providers work as independent contractors and are not employed by the hospitals and other health care facilities in which they practice, this does not exempt them from their obligation to be immunized The ACIP issues recommendations for immunization of health care personnel Health care personnel should be immune to measles, mumps, rubella, varicella, pertussis, and influenza Specific recommendations for immunization of health care professionals can be found at http://www.cdc.gov/vaccines/recs/ schedules/adult-schedule.htm The Healthcare Infection Control Practices Advisory Committee/ACIP document dealing with health care professional immunizations is being updated and can be found at http://www.cdc.gov/vaccines and http:// www.cdc.gov/ncidod/dhqp/hicpac.html when it is published Health care professionals who may be exposed to blood or body fluids should be protected against hepatitis B [13], all health care personnel should be immunized annually against influenza [21], and laboratory personnel who handle specimens or cultures containing Neisseria meningitidis should be immunized with MCV4 if they are aged !56 years and with meningococcal polysaccharide vaccine if they are aged у56 years Nosocomial outbreaks of measles and rubella were once common The transmission of measles has involved many health care settings, including physicians’ offices and emergency departments and has occurred from patients to health care personnel as well as the reverse [4, 19, 64–78] The sources of nosocomial rubella have been both patients (including infants with congenital rubella) and medical personnel [70–73] Some exposures have occurred in obstetrical clinics, infecting pregnant patients; infection of pregnant health care providers also has occurred Although less frequent, nosocomial transmission of mumps has been reported [74, 75] The endemic transmission of these viral infections in the United States has been interrupted through a concerted effort that includes routine immunization of all infants and children and vigorous public health investigation of remaining cases, including cases imported into this country from abroad [4] Nevertheless, the assurance of immunity of the health care workforce will need to continue There is a group of parents who are refusing to have their children immunized or who are delaying immunizations This produces a population of susceptible persons who can sustain an outbreak if the virus is introduced into that population Furthermore, citizens of other countries may develop these diseases shortly after their arrival mission of this highly contagious virus from health care personnel to patients in their care, many of whom are at high risk of developing serious complications, but also in preventing influenza disease among health care professionals and in reducing days of work absence Several states now require annual influenza immunization of health care professionals in acute and long-term care settings A number of professional medical and nursing societies endorse required annual influenza immunization with informed declination for health care professionals, which allows a health care professional to sign a statement acknowledging, despite recommendations, that they are refusing vaccination Immunocompromised Persons Evidence summary People may be immunocompromised due to either primary or secondary (acquired) immunodeficiency conditions Primary disorders of the immune system generally are inherited, may involve any part of the immune system, and share the common feature of susceptibility to infection with various organisms, some of which may be prevented by immunization, depending on the specific immunodeficiency Secondary deficiencies of the immune system are acquired and encompass many categories, including human immunodeficiency virus (HIV) infection, solid organ or hematopoietic malignancies, or transplantation; immunosuppression due to administration of chemotherapy or other therapeutics, such as systemic corticosteroids, radiation or monoclonal antibodies; or other chronic conditions, including diabetes mellitus, autoimmune diseases, and splenectomy People who are immunocompromised require special considerations for immunization, because they may be at increased risk for morbidity and mortality from various infections, at increased risk of serious consequences of immunizations, or at risk for inadequate response to immunization (Table 5) People with primary or secondary immunodeficiencies can be immunized safely with inactivated vaccines, which generally are recom832 • CID 2009:49 (15 September) • Pickering et al Pregnancy Recommendations 39 Providers should be aware of immunizations routinely recommended for women during pregnancy, including inactivated trivalent influenza vaccine (A-II) 40 Providers should administer appropriate vaccines to pregnant women with medical or exposure indications that put them at risk of certain vaccine-preventable diseases (A-I) 41 Following delivery, women should receive all recommended vaccines that could not be or were not administered during pregnancy (A-II) 42 Providers should be aware of and follow valid contraindications and precautions for immunizing pregnant women (A-III) Evidence summary Summarizing evidence for use of vaccines in pregnant women is hampered by lack of efficacy and safety studies in the United States Recommendations for vaccine use are largely based on disease burden and severity for mothers and newborn infants, studies reported from other countries, and expert committee opinion The only vaccines recommended in the United States for routine use during pregnancy are adult type tetanus and reduced diphtheria toxoids (Td), either for primary or booster doses, and inactivated trivalent influenza vaccines [103, 104] Other recommended vaccines are for women with medical or exposure indications that put them at increased risk of certain vaccine-preventable infectious diseases Although immunization during pregnancy poses theoretical risks, to date, there has been no evidence indicating Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Recommendations 35 All immunocompromised infants, children, adolescents, and adults should be appropriately immunized (B-II) 36 Providers should be aware of contraindications and precautions for vaccines in people with primary and secondary immunodeficiencies (B-III) 37 Providers should educate immunocompromised patients that, depending on the vaccine and their degree of immune dysfunction, the vaccines that are administered may not be fully effective (C-III) 38 Providers who care for immunocompromised patients should ensure that household contacts are immunized appropriately to reduce the risk of exposure of immunocompromised patients to vaccine-preventable diseases (B-III) mended in the same dose and on the same schedule as for immunocompetent people Response to both inactivated and live vaccines may be suboptimal, and higher doses (eg, special formulations of hepatitis B vaccine for adult patients undergoing hemodialysis and other immunocompromised adults) or additional doses (eg, for patients who have undergone transplantation) may be needed to ensure protection [33, 95–102] Live, attenuated vaccines generally are not recommended at any age for many of these groups because of known or theoretical risks of disseminated infection due to the vaccine virus [96–102] Exceptions exist, including measles-mumps-rubella and varicella vaccines, which are recommended for susceptible people with HIV infection who have a CD4+ T lymphocyte percentage у15% and no or mild symptoms of disease [100, 101] Vaccines should be administered by primary care providers or subspecialists, if responsibility for primary care has been assumed by them In addition, primary care providers should ensure that household contacts of patients with immunocompromised conditions are immunized appropriately, including with annual influenza vaccine, to reduce the risk of exposure of immunocompromised patients b Vaccine contraindication(s) Effectiveness and comments All routine vaccines probably effective; meningococcal and pneumococcal vaccines are recommended All inactivated vaccines safe and probably effective; live viral vaccines probably safe and effective Effectiveness of any vaccine depends on degree of immune suppression; recommend inactivated vaccines All routine vaccines probably effective; pneumococcal and meningococcal vaccines are recommended Effectiveness of any vaccine depends on degree of immunosuppression OPV,b smallpox, BCG, LAIV;d withhold MMR, vari- MMR, varicella, rotavirus, and all inactivated vaccella, and rotavirus in severely immunocomprocines, including influenza, may be effectivee mised children Live-bacteria vaccinesc None None All live vaccinesc,d Malignant neoplasm, transplantation, autoimmune Live-virus and -bacteria, depending on immune c,d disease, immunosuppressive or radiation status therapy HIV/AIDS Chronic granulomatous disease, leukocyte adhesion defects, myeloperoxidase deficiency Deficiency of late components (C5–C9), properdin, factor B Partial defects (eg, most patients with DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia telangiectasia) Deficiency of early components (C1–C4) OPV, smallpox, LAIV, yellow fever and live-bacte- Effectiveness of any vaccine dependent only on c ria vaccines; consider measles vaccine; no humoral response is doubtful; IGIV therapy indata for varicella or rotavirus vaccines terferes with measles and possibly varicella immune response Less-severe antibody deficiencies (eg, selective OPV;b other live vaccinesd seem to be safe, but All vaccines probably effective; immune response IgA deficiency and IgG subclass deficiencies) caution is urged may be attenuated Complete defects (eg, severe combined immuno- All live vaccinesc,d All vaccines ineffective deficiency, complete DiGeorge syndrome) Severe antibody deficiencies (eg, X-linked agammaglobulinemia and common variable immunodeficiency) Examples of specific immunodeficiency e d c b a All children and adolescents should receive an annual age-appropriate inactivated influenza vaccine LAIV is indicated only for healthy people aged through 49 years OPV vaccine no longer is recommended for routine use in the United States Live-bacteria vaccines: BCG and Ty21a Salmonella typhi vaccine Live-virus vaccines: LAIV; MMR; measles, mumps, rubella and varicella vaccine; OPV; varicella; yellow fever; vaccinia (smallpox); rotavirus; and herpes zoster HIV-infected children should receive Ig after exposure to measles and may receive varicella vaccine if CD4+ T lymphocyte count is у15% of that expected for age [99] NOTE Reproduced with permission from [95] BCG, bacille Calmette-Guerin; Ig, immunoglobulin; IGIV, immunoglobulin intravenous; HIV, human immunodeficiency virus; LAIV, live, attenuated influenza vaccine; ´ MMR, measles-mumps-rubella; OPV, oral poliovirus Secondarya Phagocytic function Complement T lymphocyte (cell-mediated and humoral) B lymphocyte (humoral) Primary a Category Table Immunization of Children and Adolescents with Primary and Secondary Immune Deficiencies Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 834 • CID 2009:49 (15 September) • Pickering et al before active protection in the infant is achieved after completion of the 3-dose primary DTaP immunization series at months of age Since 2004, ∼90% of pertussis-related deaths and severe complications have occurred in infants aged р3 months, and 75% of these infants acquired their infection from a household member—most frequently the mother [109] Although the ACIP was concerned about protecting young infants from pertussis, the committee was hesitant to recommend vaccination of pregnant women because of limited data in this population Studies indicate that healthy women who are pregnant are at increased risk of serious complications including death from influenza A study of ∼2200 women given inactivated trivalent influenza vaccine during pregnancy reported no adverse effects in the infants who were observed for years An estimated million women were immunized during the period 2000–2003 with inactivated trivalent influenza vaccine; only injection site reactions, systemic reactions, and miscarriages (not elevated above background rate) were reported [21] Inactivated trivalent influenza vaccine should be administered to all women who will be pregnant during the influenza season, regardless of trimester Influenza immunization of a woman during pregnancy also appears to protect infants aged !6 months [110] Infants aged !6 months cannot be immunized or receive antiviral prophylaxis, because no products are licensed for this age group Live, attenuated influenza vaccine (LAIV) is not licensed for use in pregnant women and should not be administered However, pregnant women not need to avoid contact with people who have received LAIV [21] Pregnant women with endemic or epidemic exposures to certain vaccine-preventable diseases should receive certain vaccines, because the risk of serious disease outweighs the theoretical risk of adverse effects on the mother or fetus These vaccines include hepatitis B vaccine, quadrivalent meningococcal conjugate vaccine (which is preferred, although quadrivalent meningococcal polysaccharide vaccine is acceptable), and parenteral typhoid vaccine Rabies vaccine should be administered only if exposure occurs Hepatitis A vaccine and inactivated polio virus vaccine can be given if travel to an area of endemicity is unavoidable Japanese encephalitis vaccine and yellow fever vaccine should be administered only if travel to a region of endemicity cannot be avoided and if the risk for exposure is significant Live, attenuated vaccines (eg, LAIV; measles, mumps, and rubella vaccine; varicella vaccine; and oral typhoid vaccines) should be avoided during pregnancy [103] Previously unimmunized pregnant women or women who have not been immunized during the previous years should receive pneumococcal polysaccharide vaccine if they are at increased risk of acquiring serious infection due to Streptococcus pneumoniae [103] Women at increased risk include those with underlying medical conditions (eg, women with diabetes mel- Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 vaccines used today have detrimental effects on the fetus or on a pregnant woman In principle, live, attenuated vaccines are of more concern because of adverse fetal effects; thus, live, attenuated vaccines should not be given to pregnant women ACIP recommendations for pregnant women can be found at http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm Women who have not received a Td-containing booster during the previous 10 years and women who are unimmunized or incompletely immunized should complete the primary Td series In 1999, the World Health Organization (WHO) launched the Maternal and Neonatal Tetanus Elimination initiative, giving women doses of tetanus toxoid vaccine during pregnancy and dose during each subsequent pregnancy up to a total of doses By December 2008, 12 countries and 15 states and Union Territories in India had eliminated maternal and neonatal tetanus, whereas 46 countries had not met the WHO Maternal and Neonatal Tetanus Elimination goal (http: //www.who.int) This program of tetanus toxoid administration during pregnancy has been associated with a striking decrease in infant mortality rates attributable to tetanus and has not demonstrated adverse effects in mothers or fetuses [105] Pertussis is the only vaccine-preventable disease that is increasing in the United States Waning immunity, which starts ∼7 years after the or childhood pertussis immunizations, is a cause [106] In 2005, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine was licensed and recommended as a one-time replacement of the decennial Td booster for people aged 18 through 64 years If a pregnant woman has not received a Td vaccination within the past 10 years, administer Td during the second or third trimester of pregnancy If the woman received her most recent Td vaccination !10 years previously, administer Tdap during the immediate postpartum period The postpartum Tdap dose should be administered before discharge from the hospital or birthing center or, if that is not possible, as soon as feasible thereafter A dose of Tdap is not only recommended for those postpartum women but also for close contacts of infants aged !12 months and for all health care personnel with direct patient contact if they have not previously received Tdap An interval for Tdap administration as short as years from the most recent Td dose is suggested; shorter intervals can be used Td can be deferred during pregnancy, and Tdap can be substituted in the immediate postpartum period, or Tdap can be administered instead of Td to a pregnant woman after an informed discussion with the woman [107] In addition, the AAP and the ACOG have issued recommendations that go beyond those of the ACIP Both the AAP and the ACOG recommend that pregnant women who have not received a Td-containing booster in the previous years should be immunized with Tdap vaccine during pregnancy [108] This recommendation is based on the desire to provide passive immunity to infants from mothers International Travel Recommendations 43 Providers who care for people who travel should ensure that all country-specific vaccines are administered in a time frame that ensures optimal development of protection (A-I) 44 Health care professionals should be aware of key sources of information regarding immunization of travelers at every age (B-III) Evidence summary People travel internationally for many reasons, including tourism, business, education, and visits to relatives and friends Although clinics that specialize in pretravel advice, including immunizations, are located in many areas, primary care providers should be able to provide basic pretravel services and advice, including providing information about immunizations to people planning international travel or referring people to clinics that specialize in travel medicine The major immunization issues to consider in immunizing travelers are status of routinely recommended immunizations and need for travel-specific immunizations [111] To ensure that routinely recommended immunizations are up to date, knowledge of a patient’s previous immunization history and medical history is necessary The use of travel-specific immunizations is based on scientific evidence of benefits, risks, and (if few or no data are available) expert opinion Immunizations should be individualized depending on the traveler’s immunization and medical history, the specific travel itinerary, season, living conditions during the journey, mode and purpose of travel, and the amount of time before departure [112, 113] Ideally, a traveler should arrange an appointment with a travel medicine health care provider 4–6 weeks before departure [114] Countryspecific immunization information is available for all countries (http://www.cdc.gov/travel and http://www.who.int/ith/en/ ) [115, 116] Immunizations for travel may be categorized into groups: required (ie, those that may be required to cross international borders) and recommended (ie, those recommended according to risk for infection in the area of travel) [111] Immunization schedules according to accepted standards are available for children, adolescents [94, 117], and adults, as well as pregnant travelers [118] Special recommendations may be necessary for people who are immunocompromised [119] Also, accelerated schedules are available for the traveler without adequate time before travel for both routinely recommended as well as travel immunizations Internationally Adopted Children Recommendations 45 Providers should accept only written documentation as evidence of previous immunization (B-III) 46 Providers should be aware of the various approaches that can be followed if there is concern about whether vaccines administered to an international adoptee were immunogenic (B-III) Evidence summary In 2007, ∼21,000 children were adopted into the United States from countries around the world [120], with 90% of international adoptees coming from countries in Asia, Central and South America, and Eastern Europe The diverse birth countries of origin of these children, their previous living circumstances (orphanages and/or foster care), potential gaps in their medical histories before adoption, and lack of reliable health care for some of these children, particularly children from developing countries, make the medical evaluation, including immunization history, of internationally adopted children difficult Before admission to the United States, all internationally adopted children are required to have a medical examination performed by a physician designated by the US Department of State in their country of origin This examination is limited to completing legal requirements for screening for certain communicable diseases and examination for serious physical and mental illness that would prevent the issuance of a permanent residency visa This evaluation is not comprehensive and does not thoroughly assess immunization status During any preadoption visits, pediatricians and other health care professionals should stress the importance of acquiring immunization and other health care records Internationally adopted children who are aged !10 years are exempt from Immigration and Nationality Act regulations pertaining to immunization of immigrants IDSA Immunization Guidelines • CID 2009:49 (15 September) • 835 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 litus, chronic lung disease, liver disease, or HIV infection or immunocompromised women) and women with functional or anatomical asplenia Pregnant women immunized years previously with meningococcal polysaccharide vaccine should receive meningococcal conjugate vaccine if they have functional or anatomical asplenia, have a terminal complement component deficiency, or are working in a microbiology laboratory where exposure to N meningitidis is routine These groups of women have an increased risk of developing invasive meningococcal infection [103] The final consideration for pregnant women is to provide certain vaccines postpartum before hospital discharge Vaccines recommended in this circumstance are measles-mumps-rubella vaccine for rubella-nonimmune women, measles-mumps-rubella vaccine for women who previously had not received doses of a measles-containing vaccine, Tdap as described above, and varicella for women who are nonimmune or if a second dose of varicella vaccine was not administered previously Breast-feeding is not a contraindication to maternal postpartum immunization, including use of live, attenuated viral vaccines Table Vaccine Resource Web Sites Organization Health professional associations American Academy of Family Physicians Web site(s) http://www.familydoctor.org American Academy of Pediatrics American Academy of Pediatrics Childhood Immunization Support Program http://www.aap.org http://www.cispimmunize.org American College of Physicians American Medical Association http://www.acponline.org/ http://www.ama-assn.org American Nurses Association Association of State and Territorial Health Officials http://www.nursingworld.org http://www.astho.org Association of Teachers of Preventive Medicine Canadian Paediatric Society http://www.atpm.org http://www.caringforkids.cps.ca Infectious Diseases Society of America National Foundation for Infectious Diseases http://www.idsociety.org http://www.nfid.org National Medical Association Nonprofit groups and universities Albert B Sabin Vaccine Institute Allied Vaccine Group http://www.nmanet.org http://www.sabin.org http://www.vaccine.org http://www.texaschildrens.org/CareCenters/Vaccine/Team.aspx http://www.childrensvaccine.org Every Child by Two Global Alliance for Vaccines and Immunization Group on Immunization Education, Society of Teachers and Family Medicine Health on the Net Foundation http://www.ecbt.org http://www.gavialliance.org/ http://www.immunizationed.org http://www.hon.ch National Healthy Mothers, Healthy Babies Coalition Immunization Action Coalition http://www.hmhb.org http://www.immunize.org Institute for Vaccine Safety, Johns Hopkins University Institute of Medicine http://www.vaccinesafety.edu http://www.iom.edu/IOM/IOMHome.nsf/Pages/ immunization+safety+review National Alliance for Hispanic Health National Network for Immunization Information Parents of Kids with Infectious Diseases Texas Children’s Hospital Vaccine Center http://www.hispanichealth.org http://www.immunizationinfo.org http://www.pkids.org http://www.vaccine.texaschildrenshospital.org The Vaccine Education Center at the Children’s Hospital of Philadelphia The Vaccine Page http://www.vaccine.chop.edu http://www.vaccines.com Government organizations Centers for Disease Control and Prevention http://http://phil.cdc.gov/phil (image library), http://wwwn.cdc.gov/ travel/contentVaccinations.aspx, and http://www.cdc.gov/ vaccines US Food and Drug Administration National Vaccine Program Office http://www.fda.gov/cber/vaccines.htm http://www.hhs.gov/nvpo/ National Institute of Allergy and Infectious Diseases World Health Organization http://www3.niaid.nih.gov/dmid/vaccines http://www.who.int/immunization/en/ before arrival in the United States Adopting parents are required to sign a waiver indicating their intentions to comply with US-recommended immunizations within 30 days after the child arrives in the United States [121] The ability of a health care provider in the United States to determine that an adoptee is protected against vaccine-preventable diseases is limited Only written documentation should 836 • CID 2009:49 (15 September) • Pickering et al be accepted as evidence of previous vaccination [22] Written records are more likely to predict protection if the dates of vaccine administration, intervals between doses, and the person’s age at the time of vaccination are compatible with US recommendations Not all vaccines in the US childhood immunization schedule are administered to children worldwide The majority of vaccines used worldwide are produced with Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 Center for Vaccine Awareness and Research Children’s Vaccine Program USEFUL WEB SITES FOR ADDITIONAL INFORMATION Many Web sites are available to direct the reader to useful information about immunizations Table categorizes these Web sites into those from health care professional organizations, nonprofit groups and universities, and government organizations PERFORMANCE MEASURES Quality standards should be implemented in each complementary setting in which immunizations are offered Immunizations—including those administered in complementary settings—should be entered into state or community population-based immunization information systems EXPERT PANEL MEMBERS Carol Baker (Baylor College of Medicine), Gary Freed (University of Michigan Health System), Stanley Gall (University of Louisville), Stanley Grogg (Oklahoma State University), Walter Orenstein (Bill and Melinda Gates Foundation), Larry Pickering (Centers for Disease Control and Prevention), Gregory Poland (Mayo Clinic College of Medicine), Lance Rodewald (Centers for Disease Control and Prevention), William Schaffner (Vanderbilt University School of Medicine), Patricia Stinchfield (Children’s Hospitals and Clinics of Minnesota), L J Tan (American Medical Association), and Richard Zimmerman (University of Pittsburgh School of Medicine) Acknowledgments The Expert Panel wishes to express its gratitude to Drs Joseph Bocchini, Samuel L Katz, and Georges Peter for their thoughtful reviews of earlier drafts Financial support The Infectious Diseases Society of America Potential conflicts of interest S.A.G serves as a consultant to the advisory boards and has received research grants from Merck and GlaxoSmithKline and serves on the speaker’s bureaus of Merck, GlaxoSmithKline, Sanofi Pasteur, and the Advisory Committee on Immunization Practices working group for Influenza and HPV S.E.G has received research funding from Astellas, GlaxoSmithKline, Merck, Sanofi Pasteur, MedImmune, and Wyeth; is a member of Merck’s Male Population Advisory Board for the HPV (Gardasil) vaccine; and serves on the speaker’s bureau for and has received honoraria from Merck and AstraZeneca Pharmaceuticals W.S serves on the Merck Data Safety Monitoring Board for Experimental Vaccines and has received honoraria from Sanofi-Pasteur and MedImmune G.A.P has received research grants from and serves as a consultant to the National Institute of Health, the Centers for Disease Control and Prevention, Novavax, Merck, Protein Sciences, GlaxoSmithKline, Novartis, CSL Limited, PowderMed, and Avianax R.Z serves on the Data Safety Monitoring Board, has received educational and research grants from Merck, and is in contract negotiations with MedImmune L.K.P., C.J.B., G.L.F, L.R., P.S., L.T., and W.A.O.: no conflicts References Disease incidence, as measured through postlicensure surveillance for vaccine-preventable diseases, should be reduced in accordance with Healthy People 2010 and 2020 goals New vaccines recommended for routine use by the ACIP should be implemented by providers within months of a published recommendation Coverage levels of у90% should be achieved within years of a published recommendation Immunization coverage should be monitored for vaccines recommended for routine use in the general population in each of the 50 states and among people of different racial or ethnic backgrounds Each practice should measure the immunization rates of patients in their care on a regular basis Maciosek MV, Coffield AB, Edwards NM, et al Priorities among effective clinical preventive services: results of a systematic review and analysis Am J Prev Med 2006; 31:52–61 Orenstein WA, Papania MJ, Wharton ME Measles elimination in the United States J Infect Dis 2004; 189(Suppl 1):S1–3 Centers for Disease Control and Prevention Achievements in public health: elimination of rubella and congenital rubella syndrome— United States, 1969–2004 MMWR Morb Mortal Wkly Rep 2005; 54: 279–82 Centers for Disease Control and Prevention Update: Measles—United States, January–July, 2008 MMWR Morb Mortal Wkly Rep 2008; 57: 893–6 Centers for Disease Control and Prevention National, state, and local area vaccine coverage among children aged 19–35 months—United States, 2007 MMWR Morb Mortal Wkly Rep 2008; 57:461–6 Centers for Disease Control and Prevention Summary of notifiable IDSA Immunization Guidelines • CID 2009:49 (15 September) • 837 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 adequate control standards and are potent if handled, transported, and stored as recommended Physicians can follow one of several approaches if a question exists about whether vaccines administered to an internationally adopted child were immunogenic or actually administered Evaluation of antibody titers can be helpful for some of the antigens (eg, diphtheria, tetanus, polio, hepatitis B, measles, mumps, and rubella) Protective levels of antitoxin to diphtheria and tetanus may be a surrogate means of assessing pertussis immunity, because the vast majority of tetanus and diphtheria toxoids administered to children are combined with pertussis vaccine An acceptable alternative when doubt exists is to reimmunize the child Tables providing recommended and alternative approaches to evaluation and immunization of internationally adopted children with no or questionable vaccination records are available elsewhere [22, 121] Diseases have been transmitted from adoptees to household members of the international adoptees’ new families [13, 14, 62, 122, 123] Health care providers should ensure that household contacts of internationally adopted children are appropriately immunized (http://www.cdc.gov/vaccines/recs/schedules/adult -schedule.htm) and that all people traveling to countries to bring their internationally adopted children to the United States are adequately immunized, including receiving hepatitis A vaccine and any other recommended travel- or country-specific vaccines (http://www.cdc.gov/travel/contentVaccinations.aspx) 7 10 11 12 13 15 16 17 18 19 20 21 22 23 24 838 • CID 2009:49 (15 September) • Pickering et al 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 tee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) MMWR Morb Mortal Wkly Rep 1999; 48(RR-05):1–15 Centers for Disease Control and Prevention Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine MMWR Morb Mortal Wkly Rep 2008; 57:258–260 Orenstein WA, Hinman AR The immunization system in the United States- the role of school immunization laws Vaccine 1999; 17(Suppl 3):S19–24 Orenstein WA, Halsey NA, Hayden GF, et al From the Centers for Disease Control: current status of measles in the United States, 1973–1977 J Infect Dis 1978; 137:847–53 Omer SB, Pan WK, Halsey NA, et al Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence JAMA 2006; 296:1757–63 Baughman AL, Williams WW, Atkinson WL, Cook LG, Collins M The impact of college prematriculation immunization requirements on risk for measles outbreaks JAMA 1994; 272:1127–32 Salmon DA, Teret SP, MacIntyre CR, et al Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future Lancet 2006; 367:436–42 Belamarich PF, Gandica R, Stein RE, et al Drowning in a sea of advice: pediatricians and American Academy of Pediatrics policy statements Pediatrics 2006; 118:e964–78 American Academy of Pediatrics Role of the medical home in familycentered early intervention services Council on Children with Disabilities Pediatrics 2007; 120:1153–8 Strebel P, Papania MJ, Dayan GH, et al Measles vaccine In: Plotkin S, Orenstein WA, Offit P, eds Vaccines 5th ed Philadelphia: Elsevier, 2008:353–98 Zimmerman RK, Mieczkowski TA, Michel M Are vaccination rates higher if providers receive free vaccines and follow contraindication guidelines? Family Medicine 1999; 31:317–23 Zimmerman RK, Janosky JE Immunization barriers in Minnesota private practices: the influence of economics and training on vaccine timing Family Practice Research Journal 1993; 13:213–24 Peckham C, Bedford H, Senturia Y, et al National immunisation study: factors influencing immunisation uptake in childhood Horsham: Action Research, 1989 Zimmerman RK, Schlesselman JJ, Mieczkowski TA, et al Physician concerns about vaccine side effects and potential litigation Arch Pediatr Adolesc Med 1998; 152:12–19 Hinman AR DTP vaccine litigation Am J Dis Child 1986; 140:528–530 Evans G, Levine EM, Saindon EH Legal issues In: Plotkin S, Orenstein WA, Offit P, eds Vaccines 5th ed Philadelphia: Elsevier, 2008: 1651–76 Orenstein WA DTP vaccine litigation, 1988 Am J Dis Child 1990; 144:517 Task Force on Community Preventive Services Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults Am J Prev Med 2000; 18:92–6 Varricchio F, Iskander J, Destefano F, et al Understanding vaccine safety information from the Vaccine Adverse Event Reporting System Pediatr Infect Dis J 2004; 23:287–94 Centers for Disease Control and Prevention Suspension of rotavirus vaccine after reports of intussusception—United States, 1999 MMWR Morb Mortal Wkly Rep 2004; 53:786–9 Murphy TV, Gargiullo PM, Massoudi MS, et al Intussusception among infants given an oral rotavirus vaccine N Engl J Med 2001; 344:564–72 Kramarz P, France EK, Destefano F, et al Population-based study of rotavirus vaccination and intussusception Pediatr Infect Dis J 2001; 20:410–6 Centers for Disease Control and Prevention Update: Guillain-Barre ´ syndrome among recipients of Menactra meningococcal conjugate vaccine—United States, June 2005-September 2006 MMWR Morb Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 14 diseases—United States, 2007 MMWR Morb Mortal Wkly Rep 2009; 56:1–94 Roush SW, Murphy TV Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States JAMA 2007; 298:2155–63 The periodic health examination Canadian Task Force on the Periodic Health Examination Can Med Assoc J 1979; 121:1193–254 Gardner P, Pickering LK, Orenstein WA, et al Guidelines for quality standards for immunization Clin Infect Dis 2002; 35:503–11 Field MJ, Lohr KN Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice Guidelines Clinical practice guidelines: directions for a new program Washington, DC: National Academy Press, 1990:52–77 Luman ET, McCauley MM, Stokley S, et al Timeliness of childhood immunizations Pediatrics 2002; 110:935–9 Centers for Disease Control and Prevention A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP); part 1: immunization of infants, children, and adolescents MMWR Morb Mortal Wkly Rep 2005; 54(RR16):1–39 Centers for Disease Control and Prevention A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part II: immunization of adults MMWR Morb Mortal Wkly Rep 2006; 55(RR-16):1–25 Centers for Disease Control and Prevention Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep 2006; 55(RR-7):1–23 Centers for Disease Control and Prevention Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep 2006; 55(RR-03):1–34 Centers for Disease Control and Prevention Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep 2005; 54(RR-07):1–21 Centers for Disease Control and Prevention Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices MMWR Morb Mortal Wkly Rep 2007; 56(RR-02):1–24 Centers for Disease Control and Prevention Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep 2009; 58(RR-2):1–24 Centers for Disease Control and Prevention Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the control and elimination of mumps MMWR Morb Mortal Wkly Rep 2006; 55:629–30 American Academy of Pediatrics Committee on Infections Diseases Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule Pediatrics 2007; 120:221–31 Centers for Disease Control and Prevention Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep 2009; 58:1–52 Centers for Disease Control and Prevention General recommendations on immunization: recommendations of the advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep (in press) National Vaccine Advisory Committee Standards for child and adolescent immunization practices Pediatrics 2003; 112:958–63 Centers for Disease Control and Prevention Combination vaccines for childhood immunization: recommendations of the Advisory Commit- 47 48 49 50 51 52 53 54 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 room visits: a risk factor for acquiring measles Pediatrics 1991; 87: 74–9 Atkinson WL, Markowitz LE, Adams NC, et al Transmission of measles in medical settings—United States, 1985–1989 Am J Med 1991; 91(Suppl 3B):320S–4S Marshall TM, Hlatswayo D, Schoub B Nosocomial outbreaks—a potential threat to the elimination of measles J Infect Dis 2003; 187(Suppl 1):S97–101 Polk BF, White JA, DeGirolami PC, Modlin JF An outbreak of rubella among hospital personnel N Engl J Med 1980; 303:541–5 Gladstone JL, Millian SJ Rubella exposure in an obstetric clinic Obstet Gynecol 1981; 57:182–6 Heseltine PNR, Ripper N, Wohlford P Nosocomial rubella—consequences of an outbreak and efficacy of a mandatory immunization program Infect Control 1985; 6:150–6 Poland GA, Nichol KL Medical students as sources of rubella and measles outbreaks Arch Intern Med 1990; 150:44–6 Wharton M, Cochi SL, Hutcheson RH, Schaffner W Mumps transmission in hospitals Arch Intern Med 1990; 150:47–9 Fischer PR, Brunetti C, Welch V, Christenson JC Nosocomial mumps: report of an outbreak and its control Am J Infect Control 1996; 24: 13–8 Parker AA, Staggs W, Dyan GH, et al Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States N Engl J Med 2006; 355:447–55 Leclair JM, Zaia JA, Levin MJ, et al Airborne transmission of chickenpox in a hospital N Engl J Med 1980; 302:450–3 Gustafson TL, Lavely GB, Brawner ER, et al An outbreak of airborne nosocomial varicella Pediatrics 1982; 70:550–6 Gustafson TL, Shehab Z, Brunell PA Outbreak of varicella in a newborn intensive care nursery Am J Dis Child 1984; 138:548–50 Weber DJ, Rutala WA, Parham C Impact and costs of varicella prevention in a university hospital Am J Public Health 1988; 78:19–23 Wright SW, Decker MD, Edwards KM Incidence of pertussis infection in healthcare workers Infect Control Hosp Epidemiol 1999; 20:120–3 Wright SW, Edwards, KM, Decker MD, et al Pertussis seroprevalence in emergency department staff Ann Emerg Med 1994; 24:413–7 Centers for Disease Control and Prevention Hospital-acquired pertussis among newborns—Texas, 2004 MMWR Morb Mortal Wkly Rep 2008; 57:600–3 Sandora TJ, Gidengil CA, Lee GM Pertussis vaccination for health care workers Clin Micro Rev 2008; 21:426–34 Denes AE, Smith JL, Maynard JE, et al Hepatitis B infection in physicians: results of a nationwide seroepidemiologic survey JAMA 1978; 239:210–2 Hadler SC, Doto IL, Maynard JE, et al Occupational risk of hepatitis B in hospital workers Infect Control 1985; 6:24–31 Occupational Safety ad Health Administration Occupational exposure to bloodborne pathogens; needlestick, and other sharps injuries; final rule Fed Reg 2001; 66:5318–25 Mahoney FJ, Stewart K, Hu H, et al Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States Arch Int Med 1997; 157:2601–5 Centers for Disease Control and Prevention Update: influenza activity—United States, 1998–1999 season MMWR Morb Mortal Wkly Rep 1999; 48:177–181 Van Voris LP, Belshe RB, Shaffer JL Nosocomial influenza B virus infection in the elderly Ann Int Med 1982; 96:153–8 Potter J, Stott DJ, Roberts MA, et al Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients J Infect Dis 1997; 175:1–6 Carman WF, Elder AG, Wallace LA, et al Effects of influenza vaccination of health-care workers on mortality of elderly people in longterm care: a randomized controlled trial Lancet 2000; 355:93–7 Burls A, Jordan R, Barton P, et al Vaccinating healthcare workers against influenza to protect the vulnerable—is it a good use of health- IDSA Immunization Guidelines • CID 2009:49 (15 September) • 839 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 55 Mortal Wkly Rep 2006; 55:1120–4 (erratum in: MMWR Morb Mortal Wkly Rep 2006; 55:1177) Baker CJ Meningococcal Working Group update 26 February 2009 Available at http://www.cdc.gov/vaccines/recs/acip/downloads/mtg -slides-feb09/13-1-menin.pdf Accessed 30 July 2009 Briss PA, Rodewald LE, Hinman AR, et al Reviews of evidence to improve vaccination coverage in children, adolescents, and adults Am J Prev Med 2000; 18:97–140 Zimmerman RK, Medsger AR, Ricci EM, et al Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics JAMA 1997; 278:996–1000 Poland GA, Shefer AM, McCauley M, et al Standards for adult immunization practices Am J Prev Med 2003; 25:144–50 Pierce C, Goldstein M, Suozzi K, et al The impact of the standards for pediatric immunization practices on vaccination coverage levels JAMA 1996; 276:626–30 Jacobson VJ, Szilagyi PG Patient reminder and patient recall systems to improve immunization rates Cochrane Database Syst Rev 2005 Tierney CD, Yusuf H, McMahon SR, et al Adoption of reminder and recall messages for immunizations by pediatricians and public health clinics Pediatrics 2003; 112:1076–82 Hinman AR, Urquhart GA, Strikas RA, National Vaccine Advisory Committee Immunization information systems: National Vaccine Advisory Committee progress report, 2007 J Public Health Manag Pract 2007; 13:553–8 Centers for Disease Control and Prevention Immunization information systems MMWR Morb Mortal Wkly Rep 2008; 57:289–91 Centers for Disease Control and Prevention Use of standing orders programs to increase adult vaccination rates: recommendations of the Advisory Committee on Immunization Practices MMWR Morb Mortal Wkly Rep 2000; 49(RR-01):15–24 BRFSS 2007–Centers for Disease Control and Prevention Behavioral risk factor survey data Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2007 D’Heilly S, Bauman WL, Nichol KL Safety and acceptability of pneumococcal vaccinations administered in nontraditional settings Am J Infect Control 2002; 30:261–8 Szilagyi PG, Rand CM, McLaurin J, et al Delivering adolescent vaccinations in the medical home: a new era? Pediatrics 2008; 121:S15–24 Centers for Disease Control and Prevention Adult immunization programs in nontraditional settings: quality standards and guidance for program evaluation: a report of the National Vaccine Advisory Committee MMWR Morb Mortal Wkly Rep 2000; 49(RR-01):1–13 Centers for Disease Control and Prevention Syncope after vaccination—United States, January 2005–July 2007 MMWR Morb Mortal Wkly Rep 2008; 57:457–60 Schaffer SJ, Fontanesi J, Rickert D, et al How effectively can health care settings beyond the traditional medical home provide vaccines to adolescents? Pediatrics 2008; 121(Suppl 1):S35–45 Centers for Disease Control and Prevention Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel MMWR Morb Mortal Wkly Rep 2006; 55(RR-17):1–33 Block AB, Orenstein WA, Ewing WM, et al Measles outbreak in a pediatric practice: airborne transmission in an office setting Pediatrics 1985; 75:676–83 Davis RM, Orenstein WA, Frank JA, et al Transmissions of measles in medical settings: 1980 through 1984 JAMA 1986; 255:1295–8 Istre GR, McKee PA, West GR, et al Measles spread in medical settings: an important focus of disease transmission Pediatrics 1987; 79: 356–8 Farizo KM, Stehr-Green PA, Simpson DM, et al Pediatric emergency 94 95 96 97 98 99 101 102 103 104 105 106 107 108 840 • CID 2009:49 (15 September) • Pickering et al 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine Pediatrics 2006; 117:965–78 Bisgard KM, Pascual FB, Ehresmann KR, et al Infant pertussis: who was the source? Pediatr Infect Dis J 2003; 22:628–34 Zaman K, Roy E, Arifeen SE, et al Effectiveness of maternal influenza immunization in mothers and infants N Engl J Med 2008; 359: 1555–64 Centers for Disease Control and Prevention General recommendations for vaccination and immunoprophylaxis In: Yellow book Available at http://wwwn.cdc.gov/travel/yellowBookCh1-GenRecVaccination.aspx Accessed 23 February 2009 National Advisory Committee on Immunization Canadian immunization guide 7th ed Ottawa, Canada: Publishing and Depository Services, 2006 Available at http://www.phac-aspc.gc.ca/publicat/cig -gci/p03-10-eng.php Accessed 23 February 2009 World Health Organization Vaccine-preventable diseases and vaccines In: International travel and health Geneva: WHO Press, 2007 Available at http://whqlibdoc.who.int/publications/2007/9789241580397_6_eng pdf Accessed 23 February 2009 Centers for Disease Control and Prevention Vaccinations—what you need to know about vaccinations and travel—a checklist 2007 Available at http://wwwn.cdc.gov/travel/contentVaccinations.aspx Accessed 23 February 2009 Centers for Disease Control and Prevention Travelers’ health—destinations 2007 Available at: http://wwwn.cdc.gov/travel/destination List.aspx Accessed 23 February 2009 World Health Organization Immunization surveillance, assessment, and monitoring—country profile sheets 2007 Available at http:// www.who.int/immunization_monitoring/en/globalsummary/country profileselect.cfm Accessed 23 February 2009 Centers for Disease Control and Prevention International travel for infants and young children In: Yellow book 2007 Available at http:// wwwn.cdc.gov/travel/yellowBookCh8-VacRecInfantsChidren.aspx Accessed 23 February 2009 Centers for Disease Control and Prevention Advising travelers with specific needs—planning for a healthy pregnancy and traveling while pregnant In: Yellow book 2007 Available at http://wwwn.cdc.gov/ travel/yellowBookCh9-PregnancyTraveling.aspx Accessed 23 February 2009 Spacek LA, Quinn TC International travel recommendations for HIV-infected patients Curr Infect Dis Rep 2004:399–403 Available at http://www.ncbi.nlm.nih.gov/sites/entrez?cmdpRetrieve&db ppubmed&doptpAbstractPlus&list_uidsp15461892 Accessed 23 February 2009 US Department of State Immigrant visas issued to orphans coming to US Available at http://travel.state.gov/family/adoption/stats/stats _451.html Accessed 23 February 2009 American Academy of Pediatrics Medical evaluation of internationally adopted children for infectious diseases In: Pickering LK, Baker CJ, Long SS, McMillan J, eds Red book: 2009 report of the Committee on Infectious Diseases 28th ed Elk Grove Village, IL: American Academy of Pediatrics, 2009:177–84 Centers for Disease Control and Prevention Update: multistate investigation of measles among adoptees from China—April 16, 2004 MMWR Morb Mortal Wkly Rep 2004; 53:323–4 Fischer GA, Teshale EH, Miller C, et al Hepatitis A among international adoptees and their contacts Clin Infect Dis 2008; 47:812–4 Downloaded from cid.oxfordjournals.org at IDSA on August 14, 2011 100 care resources? A systematic review of the evidence and an economic evaluation Vaccine 2006; 24:4212–21 Thomas RE, Jefferson TO, Demicheli V, Rivetti D Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review Lancet Infect Dis 2006; 6:273–9 American Academy of Pediatrics Immunization in special clinical circumstances In: Pickering LK, Baker CJ, Long SS, Kimberlin D eds Red book: 2009 report of the Committee on Infectious Diseases 28th ed Elk Grove Village, IL: American Academy of Pediatrics, 2009: 74–5 Centers for Disease Control and Prevention Applying public health strategies to primary immunodeficiency diseases: a potential approach to genetic disorders MMWR Morb Mortal Wkly Rep 2005; 53(RR01):1–29 Centers for Disease Control and Prevention Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation MMWR Morb Mortal Wkly Rep 2000; 49(RR-10):1–125 Centers for Disease Control and Prevention Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence MMWR Morb Mortal Wkly Rep 1993; 42(RR-4) Ljungman P, Engelhard D, de la Camara R, et al Special report: vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT Bone Marrow Transplant 2005; 35:737–46 US Public Health Service and Infectious Diseases Society of America Guidelines for preventing and treating opportunistic infections among HIV-infected children MMWR Morb Mortal Wkly Rep (in press) US Public Health Service and Infectious Diseases Society of America Guidelines for preventing and treating opportunistic infections among HIV-infected adults MMWR Morb Mortal Wkly Rep (in press) Duchini A, Goss JA, Karpen S, et al Vaccinations for adult solidorgan transplant recipients: current recommendations and protocols Clin Microbiol Rev 2003; 16:357–64 Centers for Disease Control and Prevention Guidelines for vaccinating pregnant women May 2007 Available at http://www.cdc gov/vaccines/pubs/preg-guide.htm Accessed 30 December 2008 American Academy of Pediatrics Pregnancy Pickering LK, Baker CJ, Long SS, Kimberlin D, eds Red book: 2009 report of the Committee on Infectious Diseases 28th ed Elk Grove Village, IL: American Academy of Pediatrics, 2009 World Health Organization Maternal and neonatal tetanus elimination Available at http://www.who.int/immunization_monitoring/ diseases/MNTE_initiative/en/index.html Accessed 30 December 2008 Gustafsson L, Hessel L, Storsaeter J et al Long-term follow-up of Swedish children vaccinated with acellular pertussis vaccines at 3, 5, and 12 months of age indicates the need for a booster dose at to years of age Pediatrics 2006; 118:978–84 Centers for Disease Control and Prevention Prevention of pertussis, tetanus and diphtheria in pregnant and postpartum women: recommendations from the Advisory Committee on Immunization Practices MMWR Morb Mortal Wkly Rep 2008; 57:1–48 American Academy of Pediatrics, Committee on Infectious Diseases Prevention of pertussis among adolescents: recommendations for use ... AMA, and have been endorsed by the following organizations: the AAP, the National Association of Pediatric Nurse Practitioners, and the Pediatric Infectious Diseases Society The content of the guidelines. .. the guidelines and the manuscript were reviewed and approved by the IDSA SPGC and by the Board of Directors before dissemination Guidelines and conflict of interest All members of the Expert Panel... Committee on Immunization Practices (ACIP); the ACP; the National Vaccine Advisory Committee, including the Standards for Child and Adolescent Immunization Practices and the Standards for Adult Immunization;